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November-December 1987 

Surgeon General of the Navy 
VADM James A. Zimble, MC, USN 


Naval Medical Command 

RADM Joseph S. Cassells, MC, USN 


Vol. 78, No. 6 

November- December 1987 

Public Affairs Officer 

CAPT James P. Mathews, USN 


Jan Kenneth Herman 

Assistant Editor 

Virginia M. Novinski 

Editorial Assistant 
Nancy R. Keesee 

From the Surgeon General 

1 Outreach 

From the Commander 

2 Information Flow 

Department Rounds 

4 "Bug Busting" in the Philippines 
PHC C. King, USN 

V.1I Y VEDICHE. VoL 7g. No. 6. I1SSS 0895-8211 USPS 
3I6-07Q) is published bimonthly bytbeDepartmenioftheVavy. 
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FOLICt ; Vai i Medirine is the official publication of tile 
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expressed are those of the authors a nd do not necessarily repre- 
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should he obtained from the cited reference. 

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Bethesda Consultant's Corner 

7 Oral Care for Head and Neck Cancer Patients Undergoing 
Radiation Therapy 
K.H. Baker, M.S.N., R.N 


10 The War's Most Incredible Document 
V. Uttman 

Education and Training 

14 CAMIS: Computer Assisted Medical Interactive-video System 
F. Toth, Ph.D. 
P.M. Strub, MA. 


24 Chlamydial Urethritis: The Most Frequent Form of 
Nongonococcal Urethritis 
CAPT A. D. Heggie, MC, VSNR 

Notes and Announcements 

22 Fighting Fit 

26 Oldest Navy Nurse Dies 

27 INDEX Vol. 78, Nos. 1-6, January-December 1987 

COVER: A student uses the Computer Assisted Medical Interactive- 
video System (CAMIS) in the learning resource center, Naval Hospital 
Corps School, Great Lakes, IL. The marriage of videodisc and micro- 
computer technologies has given medical education a whole new dimen- 
sion. Story on page 14. Photo by HM1 Bernt Johnson, Biomedical 
Communications Center, NHCS, Great Lakes, IL. 

From the Surgeon General 


Just as it has been properly said that "no man is an 
island" so too is it true that no successful large in- 
stitution these days can be insular or confined in its 
thinking. Navy medicine has many important areas in 
which contact with agencies and individuals outside of our 
own structure is essential to our effective functioning. Just 
as we must reach outside of our own clinical and research 
base to find new procedures, drugs, and regimens to ensure 
our medical and surgical currency, so too must we reach 
out in nonclinical areas which are also vitally important to 
our effectiveness as a military medical organization. 

Civilian medicine has made dramatic strides in nonclini- 
cal areas of endeavor. Hospital administration, from 
financial management to marketing, has been a burgeon- 
ing area of rapid progress during the past 5-10 years. From 
computerization to patient contact management, they 
have set standards which we must adopt, and adapt, in 
order to remain competitive. 

We owe it to ourselves, our patients, and the Navy to 
ensure that we are looking constantly at the state of the art 
in all facets of medicine and bringing them into our systems 
whenever and wherever we can in order to improve service, 
conserve assets, and make the very best use of our people. 
We must make the modest investments in seminars, peri- 
odicals, and other forms of communication which bring 
these forms of information to us on a regular basis in this 
exploding era of changing data. 

At the same time, as part of the United States Navy and 
Marine Corps, we must reach out to our line counterparts. 
There is an important information need which we must 
satisfy in order to complete the complex job which we do 
for the Navy/ Marine Corps team. No small part of that job 

is helping our line colleagues to understand the role and 
capabilities of Navy medicine in the fast-changing opera- 
tional environment of the 1980's. We are now a medical 
organization of fleet hospitals and massive hospital ships, 
becoming better prepared each day to handle the contin- 
gency role for which the line depends upon us. 

We must bring to our line a full and comprehensive 
understanding of what we can do for them, both in peace- 
time and when the chips are down in war. It is equally 
important that we share with them the shortcomings in 
resources and personnel which keep us, either now or in the 
future, from accomplishing the missions which the Navy 
and Marine Corps have set both for themselves and for us. 
If we do not make these shortcomings clearly known, and 
what it will take to fix them, we are letting down an 
organization which needs and depends upon us, and which 
must have a fully ready, capable medical force whenever 
they turn to us. 

Our last, but very important area of outreach is to our 
patients and beneficiaries, who must also know both that 
we are their strongest advocate for medical care and that 
caring is as much a part of our role as care itself. They, too, 
must be fully informed, both of our capabilities and our 
limitations, and with regard to the latter, what we are 
doing about correcting our deficiencies. We owe this to our 
patients in the same manner as we owe it to the operational 

Great strengths come to us from the knowledge, assur- 
ance, and information which outreach brings in. At the 
same time, we must provide these same commodities to 
those with whom we deal in order that all may know, all 
may understand, and all may eventually benefit. 

VADM James A. Zimble, MC 

November-December 1987 

From the Commander 

Information Flow 

Information is the fuel of any successful management 
effort these days. Indeed, people are talking about the 
information revolution and the fact that we are turning 
into an information society. All these things are true except 
for the last. We have turned into an information society 
and there is no turning back. 

Information channels vary so very widely, from high- 
speed data transmission circuits to the human need to 
receive vital information about diagnoses, treatment, and 
even availability of care itself. No one can be successful at 
managing anything these days unless they are prepared 
both to acquire and dispense information to those who 
need it in a complete and clearly understood manner. Not 
only must we have a clinical state of the art in our practice 
in this zero-defects medical environment which the 1980's 
have brought to us, but we must also meet informational 
needs of our own people within the Medical Department, 
our patients and beneficiaries, and the line community 
upon which we depend for resources and personnel. 

Each of the types of information I have indicated above 
is different in its essential nature, how it is packaged, who 
must get it, how quickly, and what effect it will have on the 

No one has said that information flow to these highly 
diverse audiences is easy or uncomplicated. It is neither, 
but it is certainly necessary. Whether it is regular meetings 
with hospital staff, briefings for line commanders in our 
local areas, or personal presentations to beneficiary groups 
about health care availability, we must ensure that we are 
taking every opportunity to have the facts known to those 

who must or should have this information in order to act or 

Too often, perhaps, we assume that our beneficiaries 
and our line contacts understand the status and resource 
shortcomings of Navy medicine as well as we do who work 
with these things every day. It is a dangerous assumption to 
think that everyone knows what we know on these issues, 
and a necessary effort to ensure that they do know the way 
things are and how they ought to be. 

At the same time, relating blocks of information on 
causally-bound issues is similarly important. People 
understand long waiting times for care better when they 
understand that resource shortages rather than ineffi- 
ciency or lack of caring have brought these about. What we 
are trying to do as health care finders is vitally important to 
those who cannot be accommodated in our military treat- 
ment facilities now. Our efforts to improve the utilization 
of our facilities by contract hires are similarly vitally 
important to many of our beneficiaries who will receive 
improved service through this means. The information will 
not find its way to people. We must get it there, be we 
hospital commander, health benefits advisor, ward nurse, 
or corpsman, each in our own way and within the responsi- 
bilities of our own tasks. 

Information is a commodity of which we are all con- 
sumers. In our continuing effort to provide the best service 
to every beneficiary of Navy and Marine Corps medicine, 
let us make certain that we are also competent and 
thorough information producers. 

RADM Joseph S. Cassells, MC 


PHI Rnh Lindi-I 

ADM David Jeremiah visits with BM3 Geoff Metcalfe in the 
sickbay of USS Missouri (BB-63). Jeremiah, Commander in 
Chief, Pacific Fleet, recently loured the battleship in the North 
Arabian Sea. 

November-December 1987 

Department Rounds 

"Bug Busting" 
in the Philippines 

Trekking through the dense 
Philippine jungle is dangerous 
enough during daylight hours 
when the tropical sun is hidden by a 
triple canopy of foilage. Imagine try- 
ing to climb steep, rain-soaked jungle 
ravines in the pitch-black of night, 
hoping you don't lose your footing and 
fall into a den of deadly cobras. 

This is the working environment of 
LT Robert Brian Gay, a Navy medical 
entomologist and his team of mos- 
quito busters as they track down the 
breeding areas of the elusive malaria- 
carrying mosquito, Anopheles fla- 

"Everything comes out at night in 
the jungle," LT Gay said, "including 
mosquitoes. The Anopheline breeds in 
the dense foilage and free-flowing 
streams. It's active from 8 p.m. to 5 
a.m.; so with backpack sprayers and 
ultralow-volume fans we set out 
through the Marine jungle training 
areas twice a month. 

"Each of us on the team gets about 2 
hours of sleep on a bed of bamboo. 
The rest of the night we're spraying," 

Gay said. "One night I stepped on what 
I thought was a tree log. It squealed, 
jumped up and took off, scaring the 
daylights out of me." 

The 34-year-old lieutenant is head 
of the Naval Hospital's Entomology 
Branch of the Preventive Medicine 
Unit at the 7th Fleet's largest support 
facility in the Pacific. 

"As one of 36 medical entomologists 
in the Navy, I head a team of three 
preventive medicine techs and two Fil- 

ipino biological technicians. Our job is 
to keep the Department of Defense 
personnel stationed here and visiting 
fleet sailors and marines free from dis- 
eases vectored by mosquitoes and 
other insects," Gay said. 

"In the Philippines, there are 
hundreds of species of mosquitoes plus 
other exotic insects and spiders that 
have the potential of causing big prob- 
lems for us. That's why, by being here, 
we feel tike we're on the cutting edge in 

LT Gay studies an insect specimen. 


// is the Utile buggers that worry LT Gay, like 
the malaria-carrying Anopheline mosquito 
held in a pair of tweezers (bottom). In his hand 
he holds two of the more exotic hut harmless 
beetles he found on base. 

the world of military entomology," he 

Petty Officer Second Class Steve 
Krysiak has been on the entomology 
team for 3 years. "In 1985 there were 86 
marines that came down with malaria 
they picked up at the training areas 
here. We don't want that to happen 
again," he said. "From January to 
June 1986 there were 59 reported 
cases, and so far this year we have four 
reported cases." 

"For those malaria cases treated at 
the Naval Hospital, it requires 2 weeks 
of rack time (bed rest) and the admin- 
istration of the antimalarial drug Fan- 
sidar and quinine," Gay said. 

"We've designed an integrated mos- 
quito control program strategy. We 
conduct research studies and jungle 

surveys all-year-round," Filipino bio- 
tech Lory Panganiban pointed out. He 
has been with the entomology team for 
17 years. 

"Our busiest time is May and 
November, just before and after the 
rainy season, when the streams are 
slow. Fortunately, we have a lot of 
volunteers, both American and Fil- 
ipino," he went on. 

The team's job also takes them into 
the local community and villages adja- 
cent to the naval facility and training 
areas. There they conduct medical 
civic action projects and take frequent 
blood smears for malaria. Gay dis- 
penses drugs through the local health 
officials for those people whose blood 
tests positive for the malaria parasite. 
If mosquito-breeding areas of Anoph- 

eles are found, larvacidingand chemi- 
cal spraying are done. 

"In May 1985 the population in the 
barrio of Mabayo, on the perimeter of 
the base, was found to be 25 percent 
positive for malaria. After treatment 
and monthly spraying the incident rate 
dropped to less than one percent in 
October 1986," Gay said. 

Gay and his team work closely with 
the Naval Medical Research Unit in 
Manila. The unit is conducting re- 
search at a Negrito village on the naval 
reservation. Manny Vinluan, a Fil- 
ipino bio-tech has spent a lot of time 
with the short, wiry jungle inhabitants 
who provide perimeter security to the 
base. "We're looking into the possibil- 
ity of malaria cases that are potentially 
resistant to local antimalaria medi- 

November-December 1987 

A Filipino holds his prize-fighting rooster as he has his blood taken for a malaria smear. 
The entomology team at the Subic naval facility makesfrequent visits to local barrios and 
villages around the base testing the residents for the disease. 

cine," Vinluan said. 

The team also keeps a small menag- 
erie of Philippine carabao, pigs, and 
mosquito-eating fish. 

HM Ed Boles has spent a few sleep- 
less nights collecting mosquitoes using 
a young female carabao as bait. "We 
call it a CBT, or carabao baiting trap," 
Boles explained. "Mosquitoes feed on 
the animal, then rest on the net we 
have over it. We collect the mosquitoes 
at 10 p.m. and 2 and 5 a.m. Later we 
take them back to the lab for identifi- 

Blood samples of pigs kept at the 
base riding stables are collected peri- 
odically to determine the presence of 
the Japanese B encephalitis virus. This 
is another vector-borne disease 
marked by headaches, fever, tremors, 
and convulsions. 

"Our vector control program is 
going along smoothly," Gay said. "We 
know what we have to do, and I've 
finally convinced those who control 
the purse strings to allocate more 
money for the program. So far we've 
spent $61 ,000 this year. I would like to 
see the budget increased to $100,000," 
he said. 

Entomologists like Gay agree that 
the best way to protect the troops from 
vector-borne diseases would be inocu- 
lation. The Navy and other govern- 
ment agencies are working together on 
a vaccine for malaria. 

Until a breakt hrough comes LT Gay 
and his entomology "bug busters" will 
be trekking through the jungle con- 
trolling Subic's mosquito population. 
—Story and photos by PHC Chet King, Sev- 
enth Fleet Public Affairs, Subic Bav, R.P. 

HM Boles (left) and entomology bio-tech 
Lory Panganiban check an old tire used as 
a swing, for standing water and mosquito 


Bethesda Consultant's Corner 

Oral Care for Head and Neck 
Cancer Patients Undergoing 
Radiation Therapy 

Karen H. Baker, M.S.N., R.N. 

Radiation therapy (RT) is rou- 
tinely employed in the treat- 
ment of head and neck cancer 
patients. Approximately 40,000 new 
cases of head and neck cancer are diag- 
nosed each year (Million, 1984). The 
majority of these are squamous cell 
carcinoma. A total dosage of 6,000 
rads or more is used as treatment. At 
this dosage all the complications 
caused by RT treatments can be 
encountered. Some of the side effects 
are relatively minor, others quite 
serious (Helman, 1979). These compli- 
cations are: mucositis, dysgeusia, 
xerostomia, candidiasis, trismus, radi- 
ation caries, dysphagia, and osteoradi- 
onecrosis (Table 1). 

There is general agreement in the 
nursing, dental, and medical literature 
that oral hygiene measures are of vital 
importance in preventing infections, 
promoting healing of intraoral suture 
lines and preventing further damage to 
oral mucosa. It is also of significant 
value in improving feeling of well- 
being, improving appetite, and pre- 
venting radiation-induced caries. 

The need for an oral care program 
for head and neck cancer patients in 
our facility is evident. The reasons oral 
care is not provided routinely are both 

obvious and obscure. Although all 
caregivers are aware of the value of 
oral care, it is the most overlooked 
aspect of nursing care. This omission 
may be related to the caregiver's lack 
of preparation in relating oral assess- 
ment to clinical pathology (Schweiger, 
1981), lack of time, minimization of 
the importance, not knowing how to 
give appropriate care, or the fear and 
repulsion felt by many caregivers 
toward the surgical and anatomic 
changes in these patients. 

The purpose of this article is to 
familiarize caregivers with the side 
effects of radiation on head and neck 
cancer patients, establish a plan for 
management of these side effects, 
establish an oral care protocol that is 
easy and effective, and to share the 
program Navywide so that patients 
and staff in other Navy health care 
facilities may benefit. 

Daeffler (1981) published a three- 
part article that examined oral hygiene 
measures for persons receiving chemo- 
therapy. Based on her findings, there 
are four goals in an oral hygiene pro- 

• Keep the oral mucosa clean, moist, 
soft, and intact. 

• Remove debris and plaque from 
teeth without damaging the mucosa. 

• Alleviate pain and discomfort. 

• Keep the lips clean, moist, soft, and 

Using Daeffler's Systematic Pro- 
tocol for Oral Care (1980) for persons 
receiving chemotherapy, an oral care 
protocol for head and neck patients 
receiving RT was established (Table 

Many patients who receive RT are 
treated on an outpatient basis and will 
be providing their own oral care at 
home. The plan must be simple, inex- 
pensive, and easily performed as part 
of the patient's daily routine. Includ- 
ing the patient as an active participant 
in his own care helps to ensure com- 
pliance. Patients who are hospitalized 
may be able to assume all their own 
care with little nursing intervention. 
More debilitated patients may need all 
their care performed for them. The 
patient will feel and look better, and 
withstand the arduous radiation treat- 
ments with fewer negative side effects. 

Ms. Baker is a clinical specialist in head and 
neck surgery in the Department of Otolaryngol- 
ogy, Naval Hospital, Bethesda, MD 20814. 

November-December 1987 

Figure 1. Mucosites of the tongue 

Figure 2. Radiation caries 


Radiation Side Effect 

Mucositis: Soft tissue 
inflammation of the 
oral cavity (Figure I). 

Dysgeusia: Altered 


Xerostomia: Changes in 
saliva consistency and 
reduced flow causing 
oral discomfort. 


Candidiasis: Over- 
growth of Candida al- 
bicans, normal flora 

of the oral cavity. 

Trismus: Difficulty 
opening the mouth. 


adiation Caries: Ex- 
tensive and rapid de- 
cay of teeth (Figure 2). 

Clinical Manifestations 

Progressively worsens during RT. 
Appears during the first 2-5 weeks. 
Mucosa may be red. swollen, and 
ulcerated. Symptoms resolve 2-3 
weeks after cessation of RT. 

Increases rapidly as absorbed dose 
approaches 6,000 rads. Usually pre- 
ceeds mucositis. Some resolution 
may occur. 

Causes difficulty with chewing and 
swallowing. May be noted by the third 
week of therapy. Saliva becomes thick 
and ropey, loses its buffering and anti- 
microbial action. pH of saliva drops 
from 7 to 5.5 or lower. May resolve 
6-12 months after treatment. 

Forms white elevated patches that re- 
sembles milk curds. May develop in 
any area of the mouth. This infection 
must be treated medically. 

Motor disturbance of the trigeminal 
nerve resulting in difficulty opening 
the mouth. Generally develops 3-6 
months after RT is completed. 

Results from changes in salivary pH 
and flow. Treatment is scrupulous 
dental and oral care. 

! Dysphagia: Difficulty 

May be secondary to surgery, xero- 
stomia, and < or mucositis. 

Radiation-induced fi- 
brosis and avascularity 
of bone (Figure 3). 

Occurs most commonly in the mandi- 
ble. Best treatment is prevention. 


Bersani G, Carl W: Oral care for cancer 
patients. Am J Nurs, April 1983, pp 533-536. 

Daeffler R; Oral hygiene measures for pa- 
tients with cancer, 1. Cancer Nurs 3(5):347-456, 

Daeffler R: Oral hygiene measures for pa- 

tients with cancer, II. Cancer Nurs 3(6)427-432, 

Daeffler R: Oral hygiene measures for pa- 
tients with cancer. III. Cancer Nurs 4(1 ):29-35, 

Dreizen S: Oral candidiasis. Am J Med, 30 
Oct 1984, pp 28-33. 


Oral Care Protocol for Patients Receiving RT 

1. For all head and neck patients receiving RT: 

• Interview for usual oral hygiene habits and dental history. 

• Dental consult for restorations and extractions if needed. 

• Reinforce need for meticulous oral careduring and after treatment 
Stress the importance of active participation by the patient. 

• No commercial mouthwashes, no lemon-glycerine swabs. 

• Objective and subjective assessment twice a day. 

2. For patients without signs of mucositis: 

• All of ffl. 

• Brush teeth with a soft toothbrush or toothette, floss gently after 
meals and at bedtime. 

• Petroleum jelly to lips as needed. 

3. For patients with mild mucositis: 

• All of #1, 

• If gums are too sensitive to brush and floss, a toothette or gauze pad 
wrapped around the finger can be used. 

• Prepare a solution of hydrogen peroxide and saline (1:1 or 12 it 
too effervescent), use this to soak the toothette or gauze. Swish and 
spit or wipe the mouth out being very careful to get all debris and food 
particles. Do this every 4 hours. 

• Alkaline mouthwash (sodium bicarbonate and saline), swish and 
spite as needed. Do this every 4 hours. 

• Medicated mouth rinse as ordered by the physician (Table 3). 

• Artificial saliva as needed, obtained from your pharmacy. 

4. For patients with severe mucositis: 

• All of #1. 

• All of #2, frequency should be every 2 hours. 

• Culture of mouth. 

• Bland, easily chewed and swallowed diet, no alcohol, no hot 
spicy foods, a feeding tube or parenteral feedings may be required 
to maintain nutritional status, 

• Topical anesthetics (xylocaine jelly and water painted on sore spots 
20 minutes before eating and as needed). 

• Analgesics. 

• Antibiotics. 

• Artificial saliva every 2 hours. 

• Encourage hydration, closely monitor nutritional status. 

Benadryl Elixer 
Distilled Water 
Hydrocortisone Powder 
Mycostaiin Oral Suspension 
Mylanta 1! 
Nystatin Suspension 
Tetracycline Suspension 
Consult your hospital phar- 
macist for required doses. 

Figure J. Osteoradionecrosis 

Helman J: Dental care for the irradiated pa- 
tient. Dent Surv 35:40-46, 1979. 

Million R, Cassisi.N: Management of Head 
and Neck Cancer: A Mitltidiscipiinary 
Approach. Philadelphia, JB Lippincott Co, 

Sehweiger J: Oral care and assessment in the 

critical care setting. Cril Care Update 8:26-28, 

Toljanic J, Saunders V: Radiation therapy 
and management of the irradiated patient. J 
Prosthet Dent 52(6):852-858, 1984. □ 

November-December 1987 


The War's Most 
Incredible Document 

Victor Ullman 

In past issues of Navy Medicine we 
have related the experiences of Navy 
medical personnel as POWs in the 
Philippines during World War II. The 
articles were based on diaries, logs, 
and other documents recovered from 
Bilibid when American troops liber- 
ated the pitiful survivors of that infam- 
ous Japanese prison on 5 Feb 1945. 

Once the war ended, many of the 
documents dribbled back to Washing- 
ton, some to be used for verifying the 
status of missing servicemen, others to 
form the basis for prosecuting sus- 
pected Japanese war criminals. The 
final repository for much of the mate- 
rial was the Bureau of Medicine and 
Surgery (BUM ED). 

A recent inventory turned up what 
in 1946 was called "The War's Most 
Incredible Document," the journal of 
PhMlc Robert W. Kentner. When 
war broke out in the Philippines in 
December 1941, Kentner was assigned 
to the Canacao Naval Hospital in 
Manila. With Japanese occupation of 
that city on 2 Jan 1942, Kentner, 
Canacao' s medical personnel, and 
their patients became PO Ws. 

Throughout 3 years of captivity 
Kentner kept a secret journal. Re- 
markably accurate, it contained death 
and burial records, dates of arrival and 
departure of prisoner drafts, prison 
census figures, rosters of personnel on 
duty, and floorplans and drawings of 
the Bilibid prison compound. Upon 
his repatriation in April 1945. Kentner 
personally delivered the journal to the 
Hospital Corps Archives Unit at 

"The War's Most Incredible Docu- 
ment," first appeared in the 9 Feb 1946 
Liberty magazine. 

Even on his honeymoon Pharma- 
cist Robert W. Kentner, U.S.N., 
was not allowed to forget a long 
procession of his shipmates whose 
obituaries he had written in shipshape 
Navy fashion in one of the most 
incredible documents of the war. 

Bob Kentner and his wife, Maureen, 
both of Buffalo, New York, were hav- 
ing lunch at their Asbury Park, New 
Jersey, hotel one day last June when a 
long-distance call from Chicago came 
for Kentner. 

"Please forgive me, but 1 had to call 
you," a woman's voice said. "I begged 
your mother to tell me your where- 
abouts. She said you would under- 
stand." She stifled a sob. "My brother 
was in Bilibid Prison with you, and the 
Navy told me you kept a secret diary 
and — I must know something about 
my brother." 

She mentioned a name that took 
Kentner back to the Philippines. It was 
the morning of October II, 1944, when 
Kentner said good-by to Arthur and 
watched him, with nearly 1,800 other 
prisoners, straggle out of the Bilibid 
gates for the death ride to Japan. 

"Please, Mr. Kentner," the woman 
pleaded. "My mother is dying. Just a 
little encouragement might save her. 
Can you give me any hope?" 

This was four months before the 
trickle of information began from the 
survivors of Jap prison camps. 
Kentner himself had been out of a 
naval hospital just six weeks after re- 
covering from the privations of three 
years and two months of imprison- 

The call upset him. "What could I 
tell her?" he asked his wife. "My log 
shows that Art was one of ninety-one 

pharmacists' mates in a draft of 1,784 
men that boarded a Jap freighter in 
Manila Harbor on that October morn- 
ing. Two days later the ship was sunk 
in Subic Bay and there were five survi- 
vors. None of them were pharmacist's 

Through two naval hospitals, on his 
honeymoon, and now daily at his 
Navy duties. Pharmacist Kentner has 
not been allowed to forget Bilibid Pris- 
on. He is besieged by telephone, letter, 
and personal visits. He is begged for 
some detail from his "secret diary," 
anything to provide a glimmer of hope 
for survival of their loved ones taken 
prisoner by the Japs so long ago. 

Recently, however, with more and 
more personnel records in the War 
Department and the Navy Depart- 
ment changed from MISSING IN 
relatives want to know how their boys 
looked before they died. Or did they 
give Kentner a message before they left 
for Japan and death? One girl asked, 
"Did he ever mention my name?" 

Kentner tries to remember each 
name and face out of the grim three 
years, and when he cannot offer a 
shred of solace, is as unhappy as his 
visitors. He tends to disregard the fact 
that nearly every county of every state 
has at least one family which has been 
helped by one of the most amazing 
documents of the war — an undramatic 



monument to a certain kind of 

In the armed forces this document 
has come to be known as "Kentner's 
Log." Transcribed from the scraps of 
stolen Japanese paper on which it was 
typed, the journal fills more than 200 
pages of single-spaced typing. It is no 
thrilling epic of the war or gruesome 
story of imprisonment. There are no 
adjectives in it beyond descriptive 
qualifications of fact. Terse and pur- 
poseful, this piece of writing took three 
years and two months to complete, 
and it was written under the eyes of 
Japanese guards, yet without their 

Kentner's Log contains nothing but 
names, dates, numbers, and events 
with such consecutive entries as these: 

"10-23-42: 78 men arrived from 
Cabanatuan, P.I. this date. HARBIN, 
Earl Charles, ChMachM USN, Ser. 
No. 271-90-28, died at 2245 this date. 
Cause of death: intraspinal injury (war 
injury). Buried in hospital plot, row 3, 
grave 17. Lt. L. W. King USA reported 
to this hospital this date from Cabana- 
tuan for the purpose of experimental 
work in the propagation of yeast. 

"10-25-42: Four gallons of yeast pre- 
pared and distributed to patients suf- 
fering from vitamin B deficiencies. 

"10-27-42: SADLER, Edmund F., 
Pfc, USA, ASN, 19020690, died at 
0805 this date. Cause of death: malnu- 

N'AVMEDCOM Archives 

trition. Buried in hospital plot, row 3, 
grave 18. . . ." 

In a number of ways these entries 
assisted the thousands of families 
whose loved ones are listed. They 
derived some solace from the details of 
the death and relief from the continu- 
ing torture of the words: MISSING IN 

In a more concrete way, families 
were aided financially by these factual 
entries. Both the War and Navy 
Departments accepted the identifica- 
tions and the fact of death as official 
for all listed in Kentner's Log. The 
families, therefore, were able to obtain 
the back pay, benefits, insurance and 
pensions, which could not be paid 
legally until death was established. 
The entries also helped many a wife 
and mother to accept the fact of death. 
Such as the woman in New York who 

"Can you tell me only if my husband 
was alive on November 20, 1943? If he 
was alive on that day it will make me 
very happy because it was our anniver- 
sary and 1 told our little boy that 
daddy was thinking of us. We both 
prayed for him." 

Kentner was able to inform the wife 
that on November 20, 1943, her hus- 
band was in the isolation ward and 
that the day was one of the greatest in 
the prison lives of all the emaciated 
men because the first substantial sup- 

Roberi Keniner (arrow) appears in this 
Japanese propaganda photo taken in Bil- 
ibid. August 1942. 

plies of Red Cross relief food were 
distributed. Her husband received a 
forty-seven-pound food package and 
the entire camp was filled with a holi- 
day spirit as the men ate their fill for 
the first time in almost two years. 

Since Bilibid was designated by the 
Japs as the major prisoner-of-war hos- 
pital in the Philippines, Kentner's 
careful entry of admissions from the 
other prison camps, from Japan- 
bound drafts, and from the dread 
work gangs constitutes an irrefutable 
record of conditions at these localities 
for the Americans. Day after day the 
log is filled with a record of wholesale 
admissions of patients from the work 
camps at Los Pinos, at Pasay, at Pala- 
wan, and from the road gangs in Taya- 
bas. Shortly after these admissions 
were recorded, Kentner always was 
forced to add to his records of death. 
Some of the prisoners were delivered 
dead and in sealed caskets. 

Kentner's tenacity in keeping his log 
night after night for three years two 
months, with the risk of detection con- 
stant, represents a special type of cour- 
age. That is a long time to walk under 
the sword. But Kentner explains it 

"1 was scared all the time, but I got 
all the breaks. 1 did my job, but what's 
so unusual about that? Every hospital 
corpsman in that prison did his job. I 
was assigned to the personnel office to 
work for Cliff Condon [Pharmacist 
Clifford K. Condon, U.S.N., of Val- 
lejo, California]. That was on May 30, 
1942. Cliff told me the Americans 
wouldn't be back in P.I. for two years. 
I thought he was crazy, but he said we 
were a hospital in the U.S. Navy and 
we had to follow orders as we last 
knew them. One of these orders was 
that every naval hospital keeps a 
record of its work. It was his idea, his 
orders. I did it. That's what 1 was 
trained to do." 

When Condon was shipped off on a 
Japan draft, to die in a prison camp on 
Kyushu on June 2, 1945, Kentner car- 

Novembev-Deeember 1 987 

ried on. He knew his punishment, if 
caught by the Japs, would be nothing 
less than a long prison term and he 
might be executed. 

"You get used to the danger," he 
says. "1 used to make my notes in my 
own shorthand and then type them out 
at night. You could hear the guards 
coming, for they all wore metal cleats 
on their shoes. I'd switch an official 
Jap report into the typewriter and wait 
for them to go by. Then I'd start the 
typing again. If the Japs hadn't been so 
stupid, I would never have been able to 
keep the log. Even so, I was scared all 
the time until they caught me in April 

From that date until liberation in 
February, 1945, Kentner kept his log 
under Japanese protection. It hap- 
pened this way: 

Kentner was typing in the personnel 
office late one night, when suddenly a 
voice boomed at him from the barred 

There was a snarl of "Kuda," mean- 
ing in Japanese "You no-good louse." 
Kentner recognized the voice as 
belonging to "Captain Bligh," the 
name given a sergeant of the guard 
because he was rough and totally 
Kuda. The Jap had sneaked up to peer 
into the paneless window. 

"I realized he had to go around to 
the front of the building to get at me," 
Kentner says, "so I ripped the page of 
the log out of my typewriter and 
switched in the phony report. Then I 
noticed the report was dated about six 
months ago because 1 hadn't kept it up 
to date. But it was too late to do any- 

Captain Bligh stormed in, ripped 
the sheet out, and took Kentner to the 
guard office. 

"Luckily Sato was noncom of the 
day. He could talk a little English but 
couldn't read much. He was pretty 
decent if you oiled him," Kentner says. 

"Captain Bligh gave him a long 
story in Jap, then shoved the report in 
his face. I thought 1 was through. But I 
began to oil Sato. I explained that 
Lieutenant Nogi, the hospital director 
for the Japs, wanted certain reports by 
8 A.M., and that meant working at 

night. While I talked, Sato stared at 
the report. Then he interrupted me. 

"This is a serious violation,' he said, 
which made me certain I was in the 
soup. 'I do not know what punishment 
will be given. Light bulbs must be con- 
served. You have used them at night 
without permission.' 

"It seems Captain Bligh had accused 
me of burning the lights, not typing at 
night. They sort of expected me to 
type, since I worked in the personnel 
office. Sato handed back the report. I 
staggered off and flushed it down a 
toilet. Next day I was authorized to 
burn lights at night, and to keep the 
guards from disturbing me the Japs 
also gave me a white arm band which 
said 'Office Man.' After that, it was a 

The dangers were further eased in 
July of 1944 when Kentner was named 
by Commander Thomas H. Hayes, 
Medical Corps, U.S.N., then com- 
manding officer of the hospital, as 
interpreter and liaison with the Japs to 
relieve Pharmacist Edward F. Haase, 
U.S.N., of Philadelphia, whose profi- 
ciency in the Japanese language 
almost caused his death. 

"I knew some conversational Japa- 
nese and could get along with the 
guards, but Haase really knew the lan- 
guage. He was so good they sent him 
along with a draft of prisoners for 

"When Haase left, we lost one of the 
strongest protections we had against 
the unpredictable Japs. It's hard to say 
how many lives were saved by the way 
he worked the Japs, but it was plenty. 
When 1 took over his job the responsi- 
bility scared me." 

Kentner's Log records on August 2, 
1943, that Haase, with Radio Electri- 
cian Earl G. Schweizer, U.S.N., and 
Chief Pharmacist's Mate Abel O. 
Gomes, U.S.N., were commended by 
Major General Xitiro Morimoto, 
commanding general of the Japanese 
military prison camps in the Philip- 
pines, for their work. 

The task assumed by these men 
required complete disassociation with 
themselves. They were forced to swal- 
low everything to benefit the prison- 

ers. This they did at a personal cost 
that cannot be estimated. Kentner was 
forced to assume the same sacrifices. 

His new duties allowed him to 
expand his log, since he now had all of 
the administrative reports and com- 
munications between the Japs and the 
Americans at his fingertips. 

All of these records were stuffed in a 
storage space above a noisome toilet 
outside the personnel office. The Japs 
never pried into it. When the Yanks 
took Bilibid on February 5, 1945, 
Manila was in flames and the prison 
was threatened. Kentner found an old 
Filipino Army sack and stuffed it full 
of his records. He carted this sack 
across the Pacific and delivered it to 
the Bureau of Medicine and Surgery 
on April 21, 1945. 

Commander (now Captain) Lea 
Bennett Sartin, Medical Corps, 
U.S.N., who had been commanding 
officer of the Bilibid Prison hospital 
for the first two years of its existence, 
was as amazed at Kentner's Log as any 
of the Navy men who examined it. 
Before he was imprisoned by the Japs 
at Cabanatuan, he had been in daily 
contact with Kentner, but had had no 
knowledge of the existence of the log. 

"If I had told Dr. Sartin," Kentner 
explained, "he would have run the risk 
of terrible punishment. If I'd been 
caught he would never have lied about 
the log. He's not that kind of man. He 
would have admitted knowing about it 
and tried to make my punishment eas- 
ier .. . ." 

Dr. Sartin has approved the authen- 
ticity of Kentner's records. 

As Dr. Sartin told his men, when the 
fighting man is captured he is through, 
but the hospital corpsman's work 
becomes more taxing. Perhaps it was 
the same kind of courage that moti- 
vated Kentner himself, that kept the 
hospital corpsmen going. It may have 
been training. They were organized 
from the beginning and never relaxed 
the structure of a naval hospital orga- 
nization. For instance, throughout 
Kentner's Log are entries listing pro- 
motions of hospital corpsmen follow- 
ing examination for advancement in 
rating. They held one examination 



when the Japs gave them an unex- 
pected holiday. 

With consistent restraint (Centner 
records many crises in the prison, but 
there is one that overshadows all 
others. It had such explosive possibili- 
ties that on November 1 1 , 1943, Com- 
mander Hayes, then Senior Medical 
Officer, expressed the relief of all the 
prisoners when he ordered Kentner to 
place in the service records of thirty- 
seven hospital corpsmen this commen- 

"11-8-43 to 11-11-43: Served as a 
member of a party of thirty-seven hos- 
pital corpsmen ordered by the Japa- 
nese to three days detached duty on 
Corregidor, to take part in the filming 
of a Japanese movie. Entire group 
commended at mast for the splendid 
manner in which they conducted 
themselves during this trying and 
undesirable duty. Their behavior 
served the best interests of all Ameri- 
can prisoners of this camp." 

For three days the camp had been 
holding its collective breath. The hos- 
pital corpsmen had to play the lead 
parts in this movie titled Down with 
the Stars and Stripes, and there were 
sixty-two other Army and Navy men 
participating, all under command of 
Lieutenant Talbee of the Army Air 

The Japs threatened reprisals if the 
men did not co-operate. The movie 
was to show the Jap home folks how 
their armies captured Bataan and Cor- 
regidor. The climax of the picture was 
the scene in which General Jonathan 
Wainwright surrendered to a Jap 
colonel. The doubtful pleasure of play- 
ing General Wainwright was awarded 
James F. Bray, Jr., Chief Pharmacist's 
Mate of Marshall, Illinois, while Ches- 
ter K. Fast, Pharmacist's Mate, 
Second Class, of Haviland, Kansas, 
took the role of his aide. 

Bray relates that in one scene they 
were placed in an automobile with the 
surrender flag out of one window and 
the American flag hanging out of the 
other. The car was one that Mrs. 
Douglas MacArthur had used while 
she was in the Philippines. 
Bray also took the part of a major, 

Forty-fifth U.S.A. Infantry, in se- 
quences calculated to serve the Fil- 
ipino population. These scenes were 
shot at a downtown Manila studio and 
depicted an American officer cruelly 
ordering his batteries to fire into a Fil- 
ipino barrio. Five hospital corpsmen 
then were ordered to enact the parts of 
an American machine-gun battery, 
and they shot blanks at Japs who 
banzaied up a slope. Bray's final as- 
signment was to don the full regalia of 
a three-star American general for 
close-ups of General Wainwright. 

From the Bilibid grapevine Bray 
later learned that the picture was 
shown in the Philippines under the 
title of The Dawn of Freedom, while 
its original title was kept for Japanese 
home consumption. 

The men who participated say there 
was no trouble, because the whole 
script was so naively childish that it 
seemed funny to them. Besides, they 
were called upon to be braver than the 
brave so that the Jap victory would 
seem even greater in the home propa- 
ganda mill. 

"We did it because we had to and 
because the fellows would suffer if 
there was any trouble," Bray added, 
"But none of us will ever get Holly- 
wood contracts. We didn't crack our 
faces once and we spoke our lines as 
though we werejust learning English. I 
hope General Wainwright never sees 
those close-ups they took of me in 
Manila, wearing his three stars and 
trying to look like a general. He could 
sue me." 

Of the thirty-seven hospital corps- 
men whose movie careers began and 
ended with this picture, only seven sur- 
vived imprisonment and the two death 
drafts for Japan. Kentner recorded 
their names among the dead and miss- 
ing on December 31, 1944, when the 
Japanese in Bilibid gave him certain 
lists to type. 

"1 had to hold onto myself when I 
typed," Kentner says. "They were all 
shipmates. I saw them go. If not for 
luck, I'd be with them at the bottom of 
the China Sea. Then 1 reached Bob 
Dick's name." 

Robert James Dick, Pharmacist's 

Mate Third Class, of Tonawanda, 
New York, was a big smiling fellow. 
He worked like a slave on the wards 
and made the patients happy by his 
perpetual joy of living. He was a pal of 
Kentner's. Dick was nineteen when 
Manila fell. He had been in the Navy 
only a year and a half. He was be- 
wildered, and Kentner gave him some 
of the stability that experience brings. 
In many messages home Dick told his 
folks Kentner was steering him. 

But Kentner was not able to steer 
Dick when he was named for the 
Japan draft of October 1 1, 1944. The 
night before the draft left, he came to 
Kentner with a penciled note to his 
mother. Three days later Bob Dick 
was dead in Subic Bay. Kentner de- 
livered the note to his mother last 

Bob Dick deserves a special place in 
the roster of Americans who have 
given their lives in this war, for he also 
left a message that was found by the 
Army. In it he expressed a philosophy 
that is shared by all his fellow hospital 
corpsmen. On March 21, 1944, all the 
prisoners were ordered by the Japs to 
write their war biographies. This is 
what Dick wrote: 

"I am a pharmacist's mate in the 
Hospital Corps of the United States 
Navy. 1 wasn't on Bataan or Corregi- 
dor and therefore I did not have the 
experiences that most of these men 
have had. Even if I had gone out to the 
front my duties would have been only 
to take care of the sick and wounded. 1 
was attached to this unit before the 
war, during the war, and I have been 
with this unit ever since we were taken 
prisoners at Santo Scholastica Col- 
lege. I have only done my part in tak- 
ing care of the sick and wounded. At 
times we were short of medicines our 
task was harder, but we did the best we 
could and that is all that can be 
expected. As far as my present state of 
mind is, all I can say is that I am an 
American." □ 

Viclor llllman was an ex-pharmacist's mate 
who had been on the staff of the Hospital Corps 
Quarterly and assigned to BUMED. Robert 
Kentner retired from the Navy in 1956 as a 
lieutenant in the Medical Service Corps. 

November-December 1987 


Education and Training 










Frank Toth, Ph.D. 
Philip M. Strub, M.A. 

In 1979 the Naval Health Sciences 
Education and Training Com- 
mand (HSETC) began develop- 
ing the Computer Assisted Medical 
Interactive-video System (CAM IS). 
This system employs converging laser 
videodisc and microcomputer technol- 
ogies to improve the quality and avail- 
ability of training in supporting school 
curriculum and operational medical 

Through videodisc technology, 
trainees can encounter highly realistic 


simulations of combat, mass casualty, 
or shipboard emergency. These can be 
accessed and replayed at will, accord- 
ing to an individual's schedule and 

By adding the microcomputer, an 
interactive environment can be created 
that automatically routes trainees 
through a comprehensive training 
matrix that continuously tailors itself 
to individual progress through the 

Interactive-video systems also allow 

An integral part of CA MIS is the laser- 
read videodisc. 

one to retrieve automatically copious 
user performance and system data, if 

In contrast, traditional audiovisual 
media such as films and videotapes are 
linear programs which pose well 
known but critical limitations. First, 
there is no adequate method for 
obtaining feedback regarding individ- 
ual use of and performance through 
each separate program. For cost-effec- 
tiveness, linear media are produced for 
the largest possible audience for each 


content area. No matter what individ- 
ual skill levels are, alt viewers start at 
the beginning of a program and pro- 
gress in rigid manner to the end, 
receiving exactly the same information 
at exactly the same pace. 

Finally, there is no room for pre- 
senting multiple or complex alterna- 
tive scenarios and certainly no means 
for varying outcomes depending on 
individual choices. 

In short, interactive-video disc 
(IVD) represents a compelling and in- 

novative means for overcoming in- 
herent shortcomings in existing 
techniques. It also provides training 
alternatives that hitherto were simply 
impossible for reasons of cost, logis- 
tics, or other practical considerations. 
CAMIS was established through 
the Program Objectives Memoran- 
dum process. The original broad goals 
of CAMIS — since enlarged upon - 
were twofold: to reduce academic 
attrition of hospital corpsman (HM) 
and dental technician (DT) in "A" and 

"C" schools, and to provide standard- 
ized inservice training at naval hospi- 
tals. Plans were developed and 
contracts let. The plan allowed for 
simultaneous installation of hardware 
delivery systems and interactive-video 
programs first at the schools, over a 
3-year period, and then, in another 3- 
year period, at all naval hospitals. 

The first 50 CAMIS carrels were 
installed in FY85 at the Naval Hospi- 
tal Corps School, Great Lakes, lL,the 
Naval School of Health Sciences and 

November- December 1987 


Photos, hv HMI Btrnl lohnsi 

CAM IS enables students to proceed at their own pace. 

Naval School of Dental Assisting and 
Technology in San Diego, CA, the 
Naval School of Health Sciences 
Bethesda, MD, and at its detachment 
in Portsmouth, VA. 

Unfortunately, completion of pro- 
grams under contract tagged far 
behind predetermined equipment de- 
livery schedules, with the result that 
only one program was provided ini- 
tially in prototype form. This initial 
program has since been refined and 
other programs delivered. These will 
be described later in this review. 

Installation of the remainder of the 
school CAM IS equipment, as well as 
that for the first 1 1 naval hospitals, 
was postponed several times by the 
long-delayed resolution of a protest 
lodged by an equipment vendor 
against Navy contracting procedures. 
The long-awaited installation will 
begin this year with an additional 67 
carrels at the schools, and 53 for 1 1 
naval hospitals. The remaining 19 hos- 
pitals will be equipped by the end of 
FY89, as shown in table. 

The stand-alone, individual training 
station is called a "carrel," a term bor- 
rowed from language labs. Each is 

equipped with an IBM or compatible 
microcomputer with 640 kilobytes 
(KB) of random access memory, 20 
megabytes (MB) hard disc drive, and 
proprietary graphics/ controller card. 
The other carrel components are a 
laser videodisc player and a high reso- 
lution color monitor with light pen. 
These reside within a locking cabinet 
equipped with a fan and casters. 

The microcomputer controls the 
laser videodisc player and generates 
graphics which can be superimposed 
over moving and still video images 
from the videodisc player. 

The laser disc player uses the con- 
stant angular velocity and optical 
reflective methods to play visual and 
audio sequences in a manner compara- 
ble to compact audiodiscs. Each side 
of a laser videodisc can contain any of 
approximately 54,000 still images, 30 
minutes of linear motion video, or 1 
hour of audio, all randomly accessible 
in less than 3 seconds. Unlike video- 
tapes, motion pictures, and phono- 
graph records, playing back videodiscs 
does not pose hazards for or degrade 

Typically, the computer program of 

each new CAM IS program is loaded 
on the hard disc from one or two 
floppy discs via a resident shell pro- 
gram. The shell program also provides 
user assistance, collects system use 
data, and permits disc formatting, 
copying, and other routine tasks. 
Trainees use the floppy drive to collect 
individual data such as their progress 
through a given program. 

The first CAM IS programs were 
designed to support the "A" school 
curriculum. CAMIS is intended to 
serve as a productivity tool in the 
hands of the instructor. Instead of a 
time-consuming remedial effort, 
instructors now refer students who 
have received low test scores on a given 
portion of the curriculum to the school 
learning resource center. There, indi- 
viduals or groups of up to three stu- 
dents review the material before being 
retested. Those who continue to expe- 
rience difficulty then receive individ- 
ual instructor attention. 

An example is the program entitled 
"Emergency Medical Conditions," Al- 
though emergency medical conditions 
comprise only 3 percent of the curricu- 
lum, their understanding is critical. It 













Per Site 

Beaufort, SC 



Bethesda, MD 




Bremerton, WA 



Camp Lejeune, NC 




Camp Pendleton, CA 




Charleston, SC" 



Cherry Point. NC 



Corpus Christi, TX 



Great Lakes, 1L 



Groton, CT 






Guantanamo Bay. Cuba 



Jacksonville, FL 



Lemoore, CA 



Long Beach, CA 



Millington, TN 



Naples, Italy 



Newport. R.I 



Oak Harbor. WA 



Oakland. CA 



Okinawa, Japan 



Orlando. FL 



Patuxent River, MD 



Pensacola, FL 



Portsmouth, VA 




Roosevelt Roads, PR 



Rota, Spain 



San Diego, CA 




Subic Bay. RP 



Yokosuka, Japan 



\SHS San Diego, CA 




NSDAT San Diego, CA 




NHCS Great Lakes, 1L 




NSHS Bethesda, MD 




NSHS Portsmouth, VA 















November-December 1987 


By touching the light pen to the screen the student, using 
interactive video, can record his responses to questions or 
retrace his steps hack through a program. A correct response 
enables him to continue with the lesson. 

The Video Generation 

With the inventions of motion pictures, television, and 
the computer, all aspects of communication have 
undergone a profound revolution. Since the 1960's tele- 
vision has become one of the most important influences 
in the average American home. Growing up with tele- 
vision has become a human condition. Never before has 
an entire generation been weaned by an electronic box 
and raised while spending many of its waking hours 
watching the "tube." 

The television revolution in the United States started 
between 1950 and 1960, and in that decade the number 
of TV sets increased from 4 to 53 million. By 1960 the 
typical household was watching television 5 hours every 
day. By 1970, 88 million TV sets were in use, and today 
there are more then 180 million turned on approxi- 
mately 8 hours a day. In less then 40 years, or one 
generation, the world has been swamped by the 
medium, and the accompanying programming made 
available through cable and satellite. While we watch 
one program, VCR's can record other programs for 
playback at a later time. 

Infants begin watching television shortly after birth 
as their mothers often relax while feeding them. The 
baby's attention is drawn to the color, movement, and 
sound on the screen, and the infant tends to watch the 
set rather than mother's face or hands. 

When children reach 2, parents often encourage them 
to watch "Sesame Street" and other educational pro- 

grams to stimulate the child's mental and motor skills. 
More often than not, television is the baby-sitter and 
has become a major cultural influence in our society. 
Television viewing can become habit-forming and in 
many homes the TV drones all day regardless of pro- 
gram or who may be watching. 

Throughout their development, children frequently 
watch television while doing homework. By the time 
they graduate from high school it is estimated that they 
will have accumulated 18,000 TV hours and only 12,000 
hours with their school curriculum. 

Not surprisingly, motion pictures and television have 
had a tremendous influence on education. In some 
schools students spend hundreds of hours in media lab 
learning to use television. Some schools even offer stu- 
dents the opportunity to produce their own daily news 

And now we have the computer, a major influence in 
our lives during the past 10 years. The ubiquitous com- 
puter is found in shopping malls, computer game 
arcades, classrooms, and homes. From youngster to 
teenager, computer games are an essential part of grow- 
ing up. Many high school graduates spent thousands of 
hours with computer games and the experience hasn't 
been all bad. Students have increased their cognitive 
skills of eye and hand coordination to a higher level 
than in any past generation. They have also mastered 
quick decision making with "pac man" and other games. 
These are the young adults now entering our military 
service schools. 

In the past, motion pictures became an important 
tool in military education and training. In 1941 the 
Navy Medical Department made the first medical train- 
ing films for use in training hospital corpsmen, to dem- 
onstrate surgical procedures, and to introduce new 
preventive medicine procedures. In the past 46 years we 
made hundreds of training films and videotapes to teach 
almost every aspect of Navy medicine. 

Now it is essential that we take advantage of the 
improved visual perception and cognitive skills gener- 
ated by the twin visual technologies of television and 
computer. When students arrive at our service schools 
we must supplement traditional training with up-to- 
date learning technology such as interactive video. This 
modern marriage of TV monitor and computer offers 
students instant feedback and reinforcement for their 
learning efforts. 

We have already laid the foundation for interactive 
video to support medical education and training in all 
fields of naval medicine in the 1990's. This is the logical 
next step in helping to prepare members of the video 
generation for the challenges they will face as members 
of the Navy Medical Department. — Frank Toth 



is one content area particularly suita- 
ble for interactive-video. The program 
consists of a series of case studies simu- 
lating the experiences of emergency 
medical technicians responding to 
calls for help. Students work singly or 
in small groups, deciding what to do 
when. Ultimately, they are asked to 
second guess a medical officer regard- 
ing the disposition of the patient and 
the likely condition encountered. 

Informal but extensive written feed- 
back from students shows a high 
degree of enthusiasm for this program. 
A recurring theme running through 
student's comments is the belief that 
CAM IS brought to life and made 
comprehensible content that in the 
classroom seemed abstract. Interest- 
ingly, high-achieving students seeking 
to improve their performance are also 
found sitting at CAMIS carrels 
reviewing the same programs. A for- 
mal, independent evaluation has only 
recently been initiated; however, pre- 
liminary data suggests that both 
groups of students improve their test 
scores by using CAMIS. 

In the hospitals, CAM IS carrels and 
programs will be located in medical 
library spaces, where learning resource 
centers are not available. Copies of all 
programs will be available, although 
those specifically designed for use in 

hospitals are also in completion and 

Such a program is "Advanced Com- 
bat Trauma Life Support for Physi- 
cians (ACTLS)." Developing 
programs to support fleet hospital 
readiness is one of the new require- 
ments assigned to CAMIS since its 

ACTLS, designed by CAPT Joseph 
V. Henderson, MC, USNR, and de- 
veloped in cooperation with the Uni- 
formed Services University of the 
Health Sciences, provides practice and 
refresher training in the trauma 
decision making skills learned through 
the Advanced Combat Life Support 
training course. It is set in the casualty 
receiving area of a combat zone fleet 
hospital, and has five highly realistic 
case studies of increasing difficulty 
and complexity. Working against a 
clock, physicians practice trauma 
management, observing the con- 
sequences of each action or inac- 

Another new requirement is sup- 
porting the refresher training/ Per- 
sonal Qualification Standard for the 
Navy Enlisted Classification (NEC) 
HM-8425and HM-8402 communities. 
Currently, six comprehensive pro- 
grams are under development which 
make heavy use of realistic case 

studies, including "Recognition and 
Management of Respiratory Condi- 
tions," and "Clinical Application of 
Laboratory Procedures." A descrip- 
tion of all CAMIS programs com- 
pleted and in development follows this 

In response to requests from all geo- 
graphic commanders, plans have been 
developed to provide CAM IS to desig- 
nated medical and dental clinics and 
branch clinics. The primary purpose is 
to provide training to locations where 
traditional education and training is 
limited or unavailable altogether. 

A prototype system is currently 
undergoing informal "sea trials" with 
the Medical Department aboard USS 
Guadalcanal. At the same time, 
research is ongoing to incorporate 
CAMIS capability into the SNAP/ 
SAMS systems intended initially for 
small combatants and submarines. 

With the recently signed memoran- 
dum of understanding with the Navy 
Management Systems Support Office, 
HSETC will develop training for inde- 
pendent duty corpsmen in the opera- 
tion of the shipboard computer 
system, SNAP Automated Medical 
Systems (SAMS). HSETC will pro- 
vide technical assistance in adopting 
SAMS for interactive-video, as well as 
supplying copies of CAMIS programs 

Best Overall Achievement 

The developer and project chosen to represent the Best Overall Achieve- 
ment in the 1987 Nebraska Interactive Videodisc Award competition is the 
Naval Health Sciences Education and Training Command for the video- 
disc entitled "Advanced Combat Trauma Life Support." 

"Advanced Combat Trauma Life Support" is a brilliant production 
notable for its outstanding dramatic presentation as well as for its excellent 
instructional design. Designed to provide experience in clinical decision 
making under combat conditions, the production presents many clinical 
options in a very realistic manner. The control structure provides a very 
large range of decision options and the user feedback design is excellent. 
The dramatic performances and the pacing of the action approach 
documentary-level realism. Overall, the production ranks with the best 
interactive videodiscs developed to date and is another milestone in the 
state of the art. 

Dr. Frank Toth (right) turns over the 
award to HSETCs Commanding Offi- 
cer, CAPT Harold M. Koenig, MC. 

November-December 1987 


to the ships which then become 
interactive-video capable. 

Since the U.S. Army is fielding its 
own much larger interactive-video sys- 
tem, HSETC has formalized its close 
liaison with the Army Academy of 
Health Sciences, Fort Sam Houston, 
TX, with a memorandum of under- 
standing sharing expertise and coordi- 
nating program development. 

HSETC has also joined the recently 

established Consortium of Medical 
Schools to introduce interactive video 
in medical education and training 
throughout academia. A primary ob- 
jective of the consortium is to offset 
the cost of developing IVD programs 
by increasing their availability and 
transportability within the U.S. medi- 
cal school community. 

By adopting CAMIS, HSETC has 
continued to maintain high standards 

in developing and utilizing the best 
technology available. Of no less great 
concern, is our commitment to a cost 
and communicator-effective system 
for our schools and hospitals. 

Dr. Toth is director of Biomedical Communi- 
cations, Management Directorate, Nava! 
Health Sciences Education and Training Com- 
mand, Bethesda, MD 20814-5022. Mr. Strub is 
deputy director. 

CAMIS Productions Completed 

504442 DD Advanced Combat Trauma Life Support 

Simulation training for nonsurgeon physicians based 
on the advanced trauma life support training. Field 
hospital and combat conditions are simulated. Five 
variations of a penetrating thoracic missile wound pro- 
vide experience in clinical decision making through case 
simulation. The cases are of increasing difficulty. 

801526 DN Emergency Medical Conditions 

29 comprehensive case studies providing remedial/ 
refresher training for curriculum support for Emer- 
gency Medical Technicians (EMT) in hospital "A" 
school. Conditions covered include angina pectoris, 
myocardial infarction, diabetes mellitus, insulin shock, 
stroke, epilepsy, and congestive heart failure. A com- 
plete glossary is included with the courseware. 

802043 DN Oral Examination Assisting 

Remedial/ refresher training for dental technician 
"A" school. Provides practice in dental charting includ- 
ing charting missing teeth, identifying various types of 
amalgams, recognition of amalgam shapes, and loca- 
tion of fillings. 

801546 DN Basic Medical Skills 

Remedial/ refresher training based on the hospital 
corps school "A" curricula. The six major lessons 
include vital signs (temperature, pulse, respiration), 
blood pressure, assessment, hemorrhage control, 
shock, and soft tissue injuries. The student may study 
these in three different modes: Learn, Review, or Look- 
up. Learn goes through all the material in a lesson in 
sequence. Review allows selection of a topic and exer- 
cises within a lesson. Look-up provides information on 
a specific topic within a lesson. 

803496 DN Mediquiz 

Basic medical knowledge, review, and drill for hospi- 
tal corps "A" school personnel in a game show format. 

35170 DN Anatomy & Physiology Introduction 

One of a nine-part refresher series including an over- 
view and lessons on homeostasis and terms of reference. 
Each lesson is further divided into normal structure and 
functions, possible disorders, vocabulary, and medical 
situations. A glossary, chart, and summary are pro- 
vided for each lesson. A test with immediate feedback is 

35171 DN Anatomy & Physiology, The Musculo- 

skeletal System 

One of a nine-part refresher series including an over- 
view and lessons on the muscular system and the skele- 
tal system. Each lesson is further divided into normal 
structure and functions, possible disorders, vocabulary, 
and medical situations. A glossary, chart, and summary 
are provided for each lesson. A test with immediate 
feedback is available. 

35172 DN Anatomy & Physiology, The Circulatory 


One of a nine-part refresher series including an over- 
view and lesson on circulation. Each lesson is further 
divided into normal structure and functions, possible 
disorders, vocabulary, and medical situations. A glos- 
sary, chart, and summary are provided for each lesson. 
A test with immediate feedback is available. 

35173 DN Anatomy & Physiology, The Respiratory 


One of a nine-part refresher series including an over- 
view and lessons on regulating breathing, expanding the 
lungs, channeling air, and the exchange of oxygen and 
carbon dioxide. Each lesson is further divided into nor- 
mal structure and functions, possible disorders, vocab- 
ulary, and medical situations. A glossary, chart, and 
summary are provided for each lesson. A test with 
immediate feedback is available. 



35174 DN Anatomy & Physiology, The Digestive 


One of a nine-part refresher series including an over- 
view and lessons on channeling food, breaking down 
food, absorbing nutrients, and removing wastes. Each 
lesson is further divided into normal structure and func- 
tions, possible disorders, vocabulary, and medical 
situations. A glossary, chart, and summary are pro- 
vided for each lesson. A test with immediate feedback is 

35175 DN Anatomy & Physiology, The Urinary & 

Reproductive System 

One of a nine-part refresher series including an over- 
view and lessons on filtering blood, voiding urine, and 
the reproductive system. Each lesson is further divided 
into normal structure and functions, possible disorders, 
vocabulary, and medical situations. A glossary, chart, 
and summary are provided for each lesson. A test with 
immediate feedback is available. 

35176 DN Anatomy & Physiology, The Endocrine 


One of a nine-part refresher series including an over- 
view and a lesson on hormone control. Each lesson is 

further divided into normal structure and functions, 
possible disorders, vocabulary, and medical situations. 
A glossary, chart, and summary are provided for each 
lesson. A test with immediate feedback is available. 

35177 DN Anatomy & Physiology, The Nervous 


One of a nine-part refresher series including an over- 
view and lessons on directing voluntary and involuntary 
responses, brain function, regulating autonomic proc- 
esses, and protecting the nervous system. Each lesson is 
further divided into normal structure and functions, 
possible disorders, vocabulary, and medical situations. 
A glossary, chart, and summary are provided for each 
lesson. A test with immediate feedback is available. 

35178 DN Anatomy & Physiology, The Integumen- 

tary System and Special Senses 

One of a nine-part refresher series including an over- 
view and lessons on protecting and perceiving the body. 
Each lesson is further divided into normal structure and 
functions, possible disorders, vocabulary, and medical 
situations. A glossary, chart, and summary are pro- 
vided for each lesson. A test with immediate feedback is 

CAMIS Programs in Production 

802458 DN Recognition and Management of Acute 

Respiratory Conditions 

Refresher training for independent duty corpsmen 
(IDC) for NEC 8425 (advanced hospital corpsman) and 
NEC 8402 (nuclear submarine medical technician). The 
major lessons will include assessment and treatment of 
anaphylaxis, asthma, bronchitis, pleurisy, pneumonia, 
and pneumothorax (tension, spontaneous, and trau- 
matic). (To be delivered in FY88) 

802459 DN Recognition and Management of 

Cardiovascular Conditions 

Refresher training for independent duty corpsmen 
(IDC) for NEC 8425 (advanced hospital corpsman) and 
NEC 8402 (nuclear submarine medical technician). Les- 
sons will include venous stasis, congestive heart failure, 
myocardial infarction with and without angina pecto- 
ris, and hypertensive crisis. (To be delivered in FY88) 

802460 DN Recognition and Management of 

Abdominal Conditions 

Refresher training for independent duty corpsmen 
(IDC) for NEC 8425 (advanced hospital corpsman) and 
NEC 8402 (nuclear submarine medicine technician). 
The major conditions will include acute gastritis, hydro- 
cele and testicular tumor, peptic ulcer disease with per- 
foration and hematemesis, staphylococcal food 
poisoning, diverticulitis, anal fissure with perirectal 

abscess, diarrhea due to fecal impaction, gonorrhea, 
and orchitis. (To be delivered in FY88) 

802461 DN Recognition and Management of Acute 
Dermatological Conditions 

Refresher training for independent duty corpsmen 
(IDC) for N EC 8425 (advanced hospital corpsman) and 
NEC 8402 (nuclear submarine medicine technician). 
The major conditions will include vesicobulbous dis- 
eases, pyodermas, dermatitis group, papulosquamous 
group, erythema group, purpuric eruptions, acneform 
conditions, pigmentary disorders, benign and malig- 
nant tumors, and sexually transmitted diseases. (To be 
delivered in FY87) 

803459 DN Recognition and Management of 

Dental Conditions 

Refresher training for independent duty corpsmen 
(IDC) for NEC 8425 (advanced hospital corpsman) and 
NEC 8402 (nuclear submarine medicine technician). 
(To be delivered in FY88) 

803460 DN Clinical Applications of Laboratory 


Refresher training for independent duty corpsmen 
(IDC) for N EC 8425 (advanced hospital corpsman) and 
NEC 8402 (nuclear submarine medicine technician). 
(To be delivered in FY88) 

November-December 1987 


803206 DN Preventive Medicine in the Combat 
Theater and Differential Diagnosis of 
Clinical Conditions 

Simulation training for physicians operating with 
Fleet Marine Forces to teach preventive medicine prac- 
tices in the combat environment, the importance of 
good preventive planning and practice to the military 
combat mission, and the role and duties of the staff 
medical officer in the preventive medicine aspects of 
combat health care. (To be delivered in FY87) 

802098 DN Dental Anatomy & Physiology 

Remedial/ refresher training for dental technician 
"A" school. The major lessons include the function of 
dental physiology and dental anatomy (structure and 
function of the teeth, mandible, and maxilla). Emphasis 
is placed on definition and terms associated with dental 
anatomy & physiology. (To be delivered in FY87) 

802099 DN Basic Medical Skills Part II 

Remedial/ refresher training based on hospital corps 
school "A" curricula. The major lessons include oxygen 
therapy, thoracic injuries, and abdominal injuries. (To 
be delivered in FY87.) 

802100 DN Basic Medical Skills Part HI & IV 

Remedial/ refresher training based on hospital corps 
school "A" curricula. The major lessons include treat- 
ment and assessment of upper and lower extremities, 
the head and nervous system, and the face, neck, eye 
and ear. (To be delivered in FY87) 

803209 DN Radiation Biology 

Training for advanced X-ray technician "C" school. 
Describes the effect of radiation of human cells includ- 
ing oncology treatment and radiotherapy. (To be de- 
livered in FY88) 

Fighting Fit 

Wellness and preventive medicine is what the Medical 
Department promotes as a matter of course. It's all part 
of (he job description. Granting patients clean bills of 
health is obviously preferable to spending time and 
resources putting them back into fighting trim. 

This philosophy is certainly not unique to our health 
providers. Line commanders concerned about their 
sailors are actively promoting health and physical fit- 
ness with innovative programs of their own. A case in 
point is the highly imaginative regimen introduced by 
VADM James £. Service, Commander, Naval Air 
Force, Pacific Fleet. In a recent letter to the Chief of 
Naval Operations, VADM Service outlined a program 
that stresses lifestyle rather than mere physical fitness. 

Well before the formal release of OPN A V1NST 
6110. fC, I had directed my staff to begin 
working on a health promotion physical fit- 
ness program that would benefit all NAVAIRP-AC ser- 
vice members — an expansion of what I had started at 
the Naval War College. The program goes beyond fit- 
ness alone to encompass many lifestyle choices — to- 
bacco, abuse, overeating, poor nutrition, and sedentary 
living. Although some resistance to change was initially 
expected, the program, coined "Fighting Fit," has 
proven to be a very effective complement to the Health 
and Physical Readiness (H&PR) programs. 

We found some problems along the way as you might 
well imagine. A number of Rec Services individual 
fitness programs were either nonexistent, geared only 

toward the elite athlete (powerlifting equipment instead 
of circuit weight training devices), or locked into the 
intramural /gear issue mode of doing business. More 
disturbing was that programs were frequently sched- 
uled for the convenience of the Rec Services staff and 
not the active duty population they served (opening 
hours of 0800, but now changed to 0530 at some bases). 
As changes have been made, mutually beneficial prog- 
ress has followed. For example, by offering timely (five 
limes per day, before, during, and after working hours) 
aerobic remedial Level I H&PR programs, facility 
usage has risen dramatically. Further, service members' 
positive perception of Rec Services as provider has 
improved, as individuals in many cases became 
"hooked" on personal fitness. Clearly, fitness centers in 
the future must play a much more active role in 
responding to the active duty sailor's needs. 

Excellent progress is being made in other areas as 
well. My staff is actively investigating and correcting 
supply system flaws that have in the past limited the 
availability of nutritionally sound food alternatives for 
the force. Aboard carriers and shore stations alike, 
environmental changes have been made to encourage 
healthier food choices through convenience and mar- 
keting. (For example: availability of salad bars, labeling 
of foods with "high performance, heart healthy" 
stickers, mirrors, and scales positioned at the head of 
chow lines, calorie counters on all tables, removal of 
condiments to a central area to avoid "impulse" sweet- 
ening and seasoning, etc.). After meeting with ADM 



82481 DN Eject and Survive 

Refresher training manual egress from the Martin 
Baker ejection seat for air crewmen. (Completed and in 
field test, 1985) 

800352 DN G-force Loss of Consciousness 

To teach naval aviators about the physiological 
effects of g-forces. A simulation is provided to allow 
naval aviators an opportunity to practice anti-g strain- 
ing maneuvers. (To be delivered in FY88) 

Commercial Productions Purchased 

803325 DN Interactive Math (Health Edutech, Inc.) 

A series of 1 1 videodisc programs covering 4 chapters 
of basic math and 5 chapters in applied algebra. 
Includes placement test, instructor's guide and learner's 

A tlas of Hematology 

8,000 microscopic images placed on a videodisc to be 
used for cell identification for medical laboratory, pa- 
thology, and transplant technicians in advanced medi- 
cal laboratory "C" school. 

Proposed CAMIS Productions 

Fleet Hospital Training Set Up 

Hospital Ship Training, Patient Transfer Techniques 

Shipboard Acute Burn Care 

Triage: And Surgical Priorities 

Triage: For Dental and Nurse Corps Officers 

Shipboard Casualty Management 

Patient Assessment for Medical Personnel 

Nuclear, Biological, Chemical Warfare: Personal 

Survival for Medical Personnel 
Combat Psychiatric Injuries 
Combat Trauma Life Support: Head Injuries 

Don Wilson, commissaries Navywide wilt begin a color- 
code labeling system, marking all items to readily iden- 
tify low sodium, low fat, and low calorie food choices 
for shoppers. Similarly, menus and recipe changes in 
the galley have been made to assure better food choices, 
along with a convenient dieter's plate. Ted Walker has 
agreed to modify training for our mess specialists so 
they can understand nutrition, fiber, sodium, and bal- 
anced diets. 

These changes have been enthusiastically accepted by 
the majority. We are working to institutionalize them 
by ensuring the Ney Award reflects such initiatives, by 
developing a presentation to be used during N A VFSSO 
Food Management Team assist visits, and by changing 
NAVAIP. PAC command inspection procedures to 
reflect the changes. 

In the area of tobacco prevention, where improve- 
ment would probably have the largest health impact, 
similar progress has been made. Smoke-free days, no 
smoking spaces being the norm rather than the excep- 
tion, and the ready availability of smoking cessation 
programs, are all aimed to reduce the incidence of this 
destructive lifestyle. It is my firm belief, strongly backed 
by epidemiological studies, that education alone will 
not produce the desired behavior change. We must, 
instead, concentrate on reducing the availability op- 
portunity to smoke. That our exchanges continue to 
encourage sales of tobacco products through low cost 
and strategic placements (i.e., checkout stands — 
impulse buying area), our base papers run full page 

cigarette ads, and cigarette machines are still readily 
available aboard our bases and ships, strikes me as 
running counter to our H&PR goals. The CO of USS 
Carl Vinson recently converted his tobacco shop into an 
Aerobics Fitness Center; more initiatives of this type are 

In order to become a successful program, integration 
of all components and attention to detail are required. If 
roads are being repaved on a given base, bicycle paths 
along the roadway should be considered. Rec Services 
personnel should actively support the Command Fit- 
ness Coordinator's remedial programs. The Medical 
Department must take an aggressive stance, emphasiz- 
ing a prospective, preventive medicine approach. And 
finally, commanding officers need to demand the sup- 
port required. There's not much sex in "wellness" but it's 
a superb force multiplier! 

Be assured that through our "Fighting Fit" program, 
your H&PR objectives are being taken very seriously. 
Scientific evaluation of our program is being conducted 
at present by personnel from the Naval Health Research 
Center, at both my own and at ADM Sam Yow's re- 
quest. I am confident the results you expect — a health- 
ier, fitter, prouder sailor— will result from our efforts. 
We're definitely on the right track and I wanted to share 
our success with the leadership that made it possible! 

With greatest respect, 
VADM James E. Service 

November-December 1987 



Chlamydial Urethritis: 

The Most Frequent Form of 
Nongonococcal Urethritis 

CAPT Alfred D. Heggie, MC, USNR 

Genital infections with Chlamydia trachomatis are 
currently the most prevalent sexually transmitted 
diseases in the United States and much of the 
industrialized world.(/-5) Chlamydial infection is the 
cause of approximately 50 percent of cases of nongonococ- 
cal urethritis (NGU), a disease that is estimated to occur 
214 times more frequently than gonococcal urethritis. (/) 

The importance of chlamydiae as sexually transmitted 
pathogens was not recognized until relatively recently 
because methods for their detection were not generally 
available. The first practical procedure for isolation of 
Chlamydia trachomatis was developed by microbiologists 
at the Naval Medical Research Institute, Bethesda, 
MD.(5) They devised a technique for growing Chlamydia 
trachomatis in cell culture. Since that time, extensive 
epidemiologic studies have been conducted using this tech- 
nique, or subsequent modification,(4,5) and the impor- 
tance of this organism as a highly prevalent sexually 
transmitted pathogen is now recognized. 

Chlamydia trachomatis was originally thought to be a 
virus because it is similar to viruses in size and, like viruses, 
is able to grow only in living cells. Chlamydiae are now 
classified as bacteria, however, because all their other 
properties are identical to those of bacteria. Like bacteria, 
they are susceptible to certain antibiotics and the infections 
they cause can be cured by appropriate antimicrobial 

NGU is a syndrome in men, of which Chlamydia tracho- 
matis is the most frequent recognized cause. Cases caused 
by chlamydiae cannot be differentiated from nonchlamy- 
dial cases except by laboratory tests for detection of these 
organisms. Men with either chlamydial or nonchlamydial 
NGU usually complain of itching of the urethra, burning 
on urination, and a mucopurulent, somewhat watery ure- 

thral discharge. In comparison with gonorrhea, the symp- 
toms are less severe, the urethral discharge is usually not as 
purulent or profuse, and the interval between sexual con- 
tact and onset of symptoms is typically longer in NGU (1-5 
weeks, with a peak at 2-3 weeks) than in gonococcal ure- 
thritis (2-6 days).(7) 

Microscopic examination of Gram-stained smears of 
urethral discharges from both gonococcal urethritis and 
NGU usually show an average of at least 5 polymorphonu- 
clear leukocytes (PMN) per oil immersion field (1000X 
magnification).^) Intracellular Gram-negative diplococci 
(Neisseria gonorrhoeae that have been phagocytized by 
PMN's) are usually present in smears of discharges from 
gonococcal urethritis and are absent in NGU. (9) In some 
men, chlamydial infection of the urethra may result in few 
or no symptoms(/0J/) and, therefore, escape detection. In 
men with gonococcal infections, asymptomatic cases are 
much less frequent. 

The acute urethral syndrome is a disorder in women that 
consists of dysuria and frequency of urination in the 
absence of significant numbers of bacteria (< 10 5 /ml) in 
voided urine samples.(/2) Chlamydia trachomatis infec- 
tion has been documented in 20 percent of women with this 
syndrome. (IS, 14) Chlamydial infections of the lower 
female genital tract frequently involve both the cervix and 
urethra. Although these infections are often asympto- 
matic, patients may present with complaints that include 
abnormal vaginal discharge, sensations of burning or itch- 
ing, dysuria, or dull pelvic pain. Diagnosis requires a gyne- 
cologic evaluation, including cultures of the cervix and 

Definitive diagnosis of chlamydial urethritis requires 
detection of Chlamydia trachomatis in urethral swabs by 
growth of the organism in cell eulture,(/5) or by demon- 



stration of the presence of chlamydial antigen in smears of 
urethral cells by fluorescent microscopy, (16) or enzyme- 
linked immunoassay. (1 7) When these tests are available, 
specimens should be collected and transported as directed 
by the laboratory involved. 

Because these procedures are complex and require spe- 
cial equipment and expertise, they are unlikely to be avail- 
able to medical personnel shipboard or in the field. 
Without these tests, a definitive diagnosis of chlamydial 
urethritis cannot be made, but in order to select appro- 
priate treatment it is still important to differentiate NGU 
from gonococcal urethritis on the basis of clinical evalua- 
tion, Gram stain examination of the urethral discharge, 
and urethral culture for Neisseria gonorrhoeae. 

Because chlamydiae have been shown to be the cause of 
approximately 50 percent of cases of NGU, treatment for 
chlamydial infection should be given when a diagnosis of 
NGU is made, even if laboratory tests for detection of 
Chlamydia trachomatis are unavailable. Treatment should 
also be given to patients in whom chlamydial infection of 
the urethra or cervix has been confirmed by laboratory 

Treatment regimens recommended by the U.S. Public 
Health Service should be followed. (2) These consist of 
tetracycline hydrochloride (500 mg, by mouth, 4 times a 
day, for 7 days) or doxycycline hyclate ( 100 mg, by mouth, 
2 times a day, for 7 days). For patients who cannot tolerate 
tetracyclines or in whom these medications are contraindi- 
cated, erythromycin base or stearate (500 mg, by mouth, 4 
times a day, for 7 days) or erythromycin ethyl succinate 
(800 mg, by mouth, 4 times a day, for 7 days) should be 
used as alternative treatments. 

Pregnant women should be treated with erythromycin 
instead of tetracycline because tetracycline may damage 
the teeth of the developing fetus. Also, because of possible 
damage to developing teeth, erythromycin should be used 
instead of tetracycline to treat chlamydial infections in 
children under 9 years of age. 

If not treated, chlamydial infection of the male urethra 
may spread via the vas deferens to the epididymis and 
cause epididymitis. Chlamydial infection is the most fre- 
quent cause of epididymitis in sexually active males under 
the age of 35.(75) In women, infection may spread from the 
lower to the upper female genital tract and cause pelvic 
inflammatory disease. (3, 19) When this complication is 
suspected, gynecologic consultation should be obtained 
because more intensive treatment is required than when 

infection is limited to the urethra or cervix. If untreated, 
this condition may result in sterility or predisposition to 
ectopic pregnancy.(20) 

Infected pregnant women, if untreated, may transmit 
the infection to their infants during delivery and the infants 
may develop chlamydial conjunctivitis or pneumonia.(2/, 
22) Untreated persons, both male and female, will also 
continue to spread this infection to their sexual contacts. 
As with other sexually transmitted diseases, sexual con- 
tacts of patients should be identified and treated whenever 

The antibiotics usually employed for treatment of 
gonorrhea are ineffective against chlamydial infections. 
Therefore, patients who have urethral infections with both 
chlamydiae and gonococci frequently develop symptoms 
of chlamydial urethritis a few days after the symptoms of 
gonococcal infection have responded to treatment. This is 
because the incubation period for chlamydial urethritis 
(1-3 weeks) is longer than that for gonococcal urethritis 
(2-6 days). 

When both infections are acquired simultaneously, the 
symptoms of gonorrhea usually appear first and cause the 
patient to seek treatment. Then, a few days after gonorrhea 
responds to treatment, the symptoms of chlamydial ure- 
thritis appear because this infection has not been eradi- 
cated by the treatment for gonorrhea. Although this 
syndrome of recurrent urethritis has been called post- 
gonococcal urethritis, it is usually unrelated to gonorrhea 
and most frequently results from chlamydial infection 
acquired during the same sexual exposure. However, the 
possibility of persistent or recurrent symptoms due to 
infection with penicillin resistant strains of Neisseria 
gonorrhoeae must be ruled out by obtaining appropriate 

Because gonococcal and chlamydial infections occur 
together so frequently, it is currently recommended that 
patients with gonorrhea be given tetracycline or doxycy- 
cline for 7 days in the dosages recommended for treatment 
of chlamydial infection, in addition to the antibiotics 
administered for treatment of gonorrhea. (2,23. 24) Eryth- 
romycin should be used for patients in whom tetracyclines 
are contraindicated or not tolerated. 

Because Chlamydia trachomatis is the cause of approxi- 
mately only 50 percent of cases of NGU, treatment for 
chlamydial infection may not cure all patients with this 
syndrome. (8) Another microorganism, Ureaplasma ureal- 
yticum, has frequently been isolated from cases of NGU 

November-December 1987 


but its role in this disease has not been clearly defined. 
Fortunately, ureaplasma is usually susceptible to both 
tetracyclines and erythromycin and, like chlamydiae, 
should be eradicated by treatment with these antibiotics. 
Most patients with NGU that recurs or persists after com- 
pletion of appropriate antimicrobial therapy are culture- 
negative for both Chlamydia trachomatis and Ureaplasma 
urea/yticum.(7) The causes of these refractory cases can 
seldom be determined. 

Prevention of sexually transmitted diseases, including 
chlamydial infections, relies primarily on education of 
personnel regarding the nature of these infections and the 
ways in which they are spread. Awareness of the health 
hazards involved may influence behavior so that sexual 
promiscuity and the likelihood of exposure will be 
decreased and/ or that infected persons will be motivated 
to seek medical attention promptly when symptoms occur. 
Although barrier methods, such as condoms, offer only 
limited protection against chlamydial and other sexually 
transmitted diseases, they should be advised for personnel 
who are likely to have multiple sexual partners. 


1. Thompson SE, Washington EW: Epidemiology of sexually trans- 
mitted Chlamydia trachomatis infections. Epidemiol Rpv5:96-I 23, 1983. 

2. Centers for Disease Control, US Public Health Service: Chlamy- 
dia trachomatis infections. Policy guidelines for prevention and control. 
Morb Mart Wkly Rep 34(suppl 3S):53S-74S. 1985. 

3. Stamm WE. Holmes KK: Chlamydia frar^omarK infections of the 
adult, in Holmes KK. Mardh P-A, Sparling PF, Wiesner PJ (eds): 
Sexually Transmitted Diseases. New York. McGraw-Hill, 1984, pp 258- 

4. Schachter J, Dawson CR: Human Chlamydial Infections. Lit- 
tleton, MA, PSG Publishing Co, 1978. 

5. Oriel JD, Ridgway GL: Genital Infection by Chlamydia Tracho- 
matis. New York, Elsevier Biomedical, 1982, 

6. Gordon FB, Quan AL: Isolation of the trachoma agent in cell 
culture. Proc Sue Exp Biol Med 1 18:354-359, 1965. 

7. Bowie WR: Urethritis in males, in Holmes KK, Mardh P-A, 
Sparling PF, Wiesner PJ (eds): Sexually Transmitted Diseases. New 
York, McGraw-Hill, 1984, pp 638-650. 

8. Bowie WR: Comparison of Gram stain and first-voided urine 
sediment in the diagnosis of urethritis. Sex Transm Dis 5:39-42. 1978. 

9. Jacob NF, Kraus SJ: Gonococcal and nongonococcal urethritis in 
men, Ann Im Med 82:7-12, 1975. 

10. Podgore JK, Holmes KK, Alexander ER: Asymptomatic urethral 

infections due to Chlamydia trachomatis in male military personnel. J 
Infect Dis 146:828, 1982. 

1 1. Karam GH, Martin DH, Flotte TR, Bonnarens FO, Joseph J R, 
Mroczkowski TF, Johnson WD: Asymptomatic Chlamydia trachomatis 
infections among sexually active men. J Infect Dis 154:900-903, 1986. 

!2. Stamm WE: Etiology and management of the acute urethral syn- 
drome, Sex Transm Dis 8:235-238, 1981. 

13. Stamm WE, Wagner KF, Amsel R, Alexander ER, Turck M, 
Counts GW, Holmes KK: Causes of the acute urethral syndrome in 
women. N Eng J Med 303:409-415, 1980. 

14. Komaroff AL: Acute dysuria in women. N Engl J Med 310:368- 
375, 1984. 

15. Ripa KT, Mardh P-A: Cultivation of Chlamydia trachomatis in 
cycloheximide-treated McCoy cells. J Clin Microbiol 6:328-331. 1977. 

16. Tarn MR, Stamm WE, Handsfield HH, Stephens R, Kuo C-C, 
Holmes KK, Dilzenberger K, Krieger M, Nowinski RC: Culture- 
independent diagnosis of Chlamydia trachomatis using monclonal anti- 
bodies. N Engl J A/erf 3 10: 1146-1 1 50, 1984. (Commercially available as 
Microtrak®, Syva Co, Palo Alto, CA). 

17. Jones MF, Smith TF, Houglum AJ, Herrmann JE: Detection of 
Chlamydia trachomatis in genital specimens by the Chlamydiazyme test. 
J Clin Microbiol 20:465-467, 1 984. (Commercially available as Chlamy- 
diazyme®, Abbott Laboratories, North Chicago, IL). 

18. Berger RE, Alexander ER, Monda GD, Ansell J, McCormick G, 
Holmes KK: Chlamydia trachomatis as a cause of acute "idiopathic" 
epididymitis, fit Engl J Med 298:301-304, 1978. 

19. Holmes KK. Eschenbach DA, Knapp JS: Salpingitis: Overview of 
etiology and epidemiology. Am J Obslei Gynecol 138:893-900, 1980. 

20. Brunham RC, Maclean IW, Binns B, Peeling RW: Chlamydia 
trachomatis: Its role in tubal infertility. J Infect Dis 152:1275-1281, 1985. 

21. Thompson SE, Dretler RH: Epidemiology and treatment of chla- 
mydial infections in pregnant women and infants. Rev Infect Dis 
4(suppl):S747-S757, 1982. 

22. Heggie AD. Jaffe AC, Stuart LA. Thombre PS, Sorensen RU: 
Topical sulfacetamide vs oral erythromycin for neonatal chlamydial 
conjunctivitis. Am J Dis Child 139:564-566, 1985. 

23. Centers for Disease Control, US Public Health Service: STD 
treatment guidelines. Morb Mori Wkly Rep 34(suppl 4S):75S-I08S, 

24. Stamm WE. Guinan ME, Johnson C, Starcher T. Holmes KK, 
McCormack WM: Effect of treatment regimens for Neisseria gonor- 
rhoeae on simultaneous infection with Chlamydia trachomatis. N Eng! J 
Med 310:545-549, 1984. □ 

Dr. Heggie is associate professor of pediatrics and pathology, Case 
Western Reserve University, School of Medicine, and attending pediatri- 
cian at the University Hospitals of Cleveland, Cleveland, OH. This 
article was written for presentation during a course on sexually trans- 
mitted diseases at Navy Environmental and Preventive Medicine Unit 
No. 2, Norfolk, VA, April 1986. 

Navy Nurse Josie Mabel Brown 

Josie Mabel Brown, the oldest Navy nurse, died in Escondido, CA, on 1 1 
Oct 1987. She was 101. Ms. Brown was the subject of an interview in the 
May-June 1986 issue of U.S. Navy Medicine. 




Vol. 78, Nos. 1-6, January-December 1987 

ABSCESS, retropharyngeal, metastatic 
carcinoma masquerading as 1:24 


medical expense and performance re- 
porting system 5:18 

A first year student's impression of CHS 


mass casualties in the aircraft carrier 
environment, management of 2:15 

Anesthesia machine, field, hidden obstruc- 
tion of 1:16 

Antabuse and optic neuritis 5:26 

Antarctica, cold temperature studies in 1:2 

Appendectomy performed aboard ship in 
1942 1:20 

BAD breath 5:22 

Baker, K.H..MSN, RN, oral care for head 
and neck cancer patients undergoing 
radiation therapy 6:7 

Bankson, J.H., medical expense and per- 
formance reporting system 5:18 

Beating the sting: operational entomolo- 
gists protect the troops 2:10 

Bendele, J.G., LCDR, NC, hidden ob- 
struction of field anesthesia ma- 
chine 1:16 


plateletpheresis 5:20 

Boone, J.T., VADM, MC (deceased) 2:22 

Boot cast 1:26 

Brittain, J.L., LCDR, MSC, Antabuse 
and optic neuritis: a case report 5:26 

Brown, J.M., oldest Navy nurse dies 6:26 

Burnette, D., LCDR, USNS Mercy 5:2 

Byrd, J. P., M.D., metastatic carcinoma 
masquerading as retropharyngeal 
abscess 1:24 

NOTE: Figures indicate the issue and page in 
Volume 78 of Navy Medicine. Forexample, 1:24 
shows the article may be found in issue No. I 
(January-February), page 24. 

CAMIS (Computer Assisted Medical In- 
teractive-video System) 6:14 

colorectal, screening for 1:6 
metastatic carcinoma masquerading as 

retropharyngeal abscess 1:24 
oral care for head and neck cancer pa- 
tients undergoing radiation therapy 
Carcinoma, metastatic, masquerading as 

retropharyngeal abscess 1:24 
Cassells, J.S., RADM, MC 
care and caring 2:1 
changing times 5:1 

Dental Corps greetings on 75th anniver- 
sary 4:2 
futurism and Navy medicine 3:1 
graduate medical education 1:1 
information flow 6:2 
Navy medicine: competitiveness and 
challenge in the 1990's 3:10 
Casts for lower extremities aboard ship 

Chaffoo, R.A.K., LCDR, MC, metastatic 
carcinoma masquerading as retro- 
pharyngeal abscess 1:24 
Chambers, T.P., ENS, MC, USNR, a first 
year student's impression of OIS 1:10 
Chester, W.L., LT, MC, USNR, hidden 
obstruction of field anesthesia 
machine 1:16 
Chlamydial urethritis: the most frequent 
form of nongonococcal urethritis 6:24 
Chobanian, S.J., CDR, MC, USNR, 

screening for colorectal cancer 1:6 
Cocrane, R.M., LT, MSC, your wartime 

mission 4:20 
Coffey, H.C., LCDR, MSC, managingthe 

patient experience 3:23 
Cold temperature studies 1:2 
Colitis, ulcerative, a review of 2:6, 3:6 
colorectal cancer, screening for 1:6 
ulcerative colitis, a review of 2:6, 3:6 

Communicable diseases 

diseases reportable by a DAR 4: 1 1 
Compatibility of Navy litters 1:13 
Computer Assisted Medical Interactive- 
video System 6: 14 
Cross, orange 2:9, 5:29 

DAR (disease alert report) 4:9 
Dembert, M.L., CDR, MC, the disease 

alert report 4:9 
Dentistry, Navy 
dental health: planning for delivery in 

the 1990's 3:17 
Fleet Marine Force 2:5 
oral care for head and neck cancer pa- 
tients undergoing radiation therapy 
osseointegration training 4:6 
plain film imaging of the TMJ 4:23 
USS La Salle's dental department 4:4 
75 years of excellence in the Dental 
Corps 4:2, 13 

Tzanck smears, plain but practical 4:26 
Disease alert report 4:9 
Disease Vector Ecology and Control Cen- 
ter (DVECC), Alameda 2:2 
Donor, blood 

Fellowes, J.H., CAPT (Ret.) 5:21 
Dr. Boone's first battles 2:22 

ECLAVEA, E., DT2, maxillofacial pros- 
thetic technician 3:4 
Education (see Training) 

Don't shoot at the orange cross! 2:9, 
"bug busting" in the Philippines 6:4 
DVECC Alameda 2:2 
new tsetse fly repellent tested in Africa 
Expense and performance reporting sys- 
tem, medical 5:18 

November-December 1987 


an eye for Aida 3:4 
ophthalmic microsurgery at sea 2:28 
optic neuritis and Antabuse 5:26 

FELLOWES, J.H., CAPT (Ret), top 

apheresis donor 5:21 

Field anesthesia machine, hidden obstruc- 
tion of 1:16 

Fighting fit 6:22 

Film imaging techniques, plain, of the 
TMJ 4:23 

Fitness 6:22 

Fleet Hospital One 3:25 

Fleet Marine Force dentistry 2:5 

Flight deck disasters 

management of mass casualties in the 
aircraft carrier environment 2:15 

Flinton. R.J., CAPT, DC, osseointegra- 
tion training in the Dental Corps 4:6 

Fraker, D., Operation Safe Haven 3:25 

GARRIGUES, N., CAPT, MC, plastic 

surgery and Navy medicine 3:2 

colorectal cancer, screening for 1:6 
Gay, R.B., LT, medical entomologist 6:4 
Geneva Convention 

Don't shoot at the orange cross! 2:9, 

law of war course 3:9 
marines are marines are marines 5:16 

nongonococcal urethritis: chlamydial 
urethritis 6:24 

HALITOSIS: diagnosis, clinical signifi- 
cance, prevention, and treatment 5:22 
Head and neck 
cancer patients undergoing radiation 

therapy, oral care for 6:7 
metastatic carcinoma masquerading as 
retropharyngeal abscess 1:24 
Health and Physical Readiness programs 

fighting fit 6:22 
Health care management 
medical expense and performance re- 
porting system 5:18 
Health care. Navy 3:10, 20, 23, 5:11, 13 
Heggie, A.D., CAPT, MC, USNR, 
chlamydial urethritis: the most fre- 
quent form of nongonococcal ure- 
thritis 6:24 
Herman, J.K. 
interview with W.B. Lipes on appendec- 
tomy performed aboard ship in 1942 
letters to the editor 1:29, 5:29 
appendectomy performed aboard ship 
in 1942 1:20 

Boone, J.T., VADM, MC (deceased) 

Dental Corps, Navy, 75 years of excel- 
lence 4:2, 13 
WWII, the war's most incredible docu- 
ment 6:10 
Ho, B.T., CAPT, MC 2:28, 5:5, 6 

Bethesda, plateletpheresis 5:20 
fleet 3:25 

smoking policy, guide to 3:20 
Human adaptability to cold, studies on 1:2 

IMAGING of the TMJ, plain film tech- 
niques 4:23 
osseointegration training in the Dental 
Corps 4:6 
In memoriam 
Brown, J.M,, oldest Navy nurse dies 
Insects 2:2, 2:10, 6:4 

Lipes, W.B., on appendectomy per- 
formed aboard ship in 1942 1:20 


marines are marines are marines 5:16 
Don't shoot at the orange cross! 2:9, 5:29 

KASHIMBA, D., NAS Alameda's 

DVECC takes the "bugs" out 2:2 
Kelly, J.F., AFCM, compatibility of Navy 

litters 1:13 
Kentner, R.W. 6:10 
King, C, PHC 
an eye for Aida 3:4 
"bug busting" in the Philippines 6:4 
USNS Mercy 5:7, 9 
Koch, R.W., RADM, DC, dental health: 
planning for delivery in the 1990's 


beating the sting: operational entomolo- 
gists protect the troops 2:10 
too cold for comfort: NMR1 scientists 
study human adaptability 1:2 
Law of war 
course 3:9 
Don't shoot at the orange cross! 2:9, 

marines are marines are marines 5:16 
Letters to the editor 1:29, 5:29 
Lewis, S., CAPT, MC 1:2 
Lipes, W.B. 1:20, 29 
Litters, Navy, compatibility of 1:13 

MANAGEMENT of mass casualties in 
the aircraft carrier environment 2:15 
Managing the patient experience 3:23 

Marine Corps, U.S. 

Fleet Marine Force dentistry 2:5 

law of war course 3;9 

marines are marines are marines 5:16 

Mass casualties in the aircraft carrier en- 
vironment, management of 2:15 

Mateczun, A. J., CDR, MC, Antabuse and 
optic neuritis: a case report 5:26 

Matheson, J.D., CAPT, DC 5:4, 9 

Mathews, J. P., CAPT, the power of per- 
ception and the future of Navy medi- 
cine 3:20 

Medical care. Navy 3:10, 20, 23, 5:1 1. 13 

Medical expense and performance 
reporting system 5:18 

Medical Personnel Unit Augmentation 
System 4:20 

Mercy medley 5:2 

Metastatic carcinoma masquerading as 
retropharyngeal abscess 1:24 

letter to the editor 1:29 
ophthalmic, at sea 2:28 

Microvascular surgery training 5:25 

Military medicine 3:10, 20, 23. 5:11, 13 

MMART (Mobile Medical Augmentation 
Readiness Team) 4:20 

Mora, W„ LCDR, MC 3:3 

Mosquitoes in Philippines 6:4 

NAVAL Medical Research Institute 
scientists study human adaptability to 
cold 1:2 

Navy medicine 3:10, 20, 23, 5:11, 13 

Neil-Robertson litter 1:13 

Neuritis, optic, and Antabuse 5:26 

Newport, R.l. 

OIS, first year student's impression of 

NMR1 1:2 

Nongonococcal urethritis chlamydial ure- 
thritis 6:24 

Nurse Corps, Navy 

Brown, J.M., oldest Navy nurse dies 

nurses and research 2:26 

OFFICER Indoctrination School (OIS), 

Newport, first year student's impres- 
sion of 1: 10 
One merchant ship, one oil tanker, and 

one successful appendectomy 1:20 
Operation Safe Haven 3:25 
Ophthalmic microsurgery at sea 2:28 
Optic neuritis and Antabuse 5:26 
Oral care for head and neck cancer patients 

undergoing radiation therapy 6:7 
Orange cross 2:9, 5:29 
Orientation at OIS Newport 1:10 
Orthopedics afloat: the lower extremities 



Osseointegration training in the Dental 

Corps 4:6 
Ozment, B.L„ CAPT, MSC, compatibility 

of Navy litters 1:13 

PATIENT management 3:23 

Perkins, R.A., LT, MC, USNR, the 

disease alert report 4:9 
Personnel, military 

Medical Personnel Unit Augmenta- 
tion System 4:20 

your wartime mission 4:20 

metastatic carcinoma masquerading as 
retropharyngeal abscess 1:24 

an eye for Aida 3:4 

"bug busting" in 6:4 

USNS Mercy's humanitarian cruise 5:2 
Physical fitness 6:22 
Plain film imaging of the TMJ 4:23 
Plastic surgery and Navy medicine 3:2 
Plateletpheresis 5:20 

the war's most incredible docu- 
ment 6:10 

an eye for Aida 3:4 

osseointegration training in the Dental 
Corps 4:6 

Mercy 5:4 

Radiation therapy, oral care for head and 
neck cancer patients undergoing 6:7 

Rector, D. 1:20 

colorectal cancer, screening for 1:6 

Reed, H.L., LCDR, MC 1:2 

Repellents, insect, testing of 2:10 

Reporting system, medical expense and 
performance 5:18 

Research and Navy nurses 2:26 

Retropharyngeal abscess, metastatic car- 
cinoma masquerading as 1:24 

Robinson, A.M., CDR, MC, ulcerative 
colitis: a review 2:6, 3:6 

SAILOR of the Year 2:27 

SAR medevac litter 1:13 

Screening for colorectal cancer 1:6 

Service, J.E., VADM, fighting fit 6:22 

Sexually transmitted disease 

chlamydial urethritis: the most fre- 
quent form of nongonococcal ure- 
thritis 6:24 

Shaffer, R.G., RADM, DC, the Navy 
Dental Corps: 75 years of excellence 

Shearer, D.R., LCDR, MC, ophthalmic 
microsurgery at sea 2:28 


management of mass casualties in the 

aircraft carrier environment 2:15 
ophthalmic microsurgery at sea 2:28 
orthopedics afloat: the lowerextremities 

USNS Mercy 3:4, 5:2 
USS Hector 2:28 
USS La Salle 4:4 
USS Seadragon 1:20 
Sholdt, L., CAPT, MSC 2.10 

Tzanck smears, plain but practical 4:26 
Smith, D. A., CDR, MSC, plateletpheresis 

spoken here 5:20 
Smoking, guide to hospital policy 3:20 
Stewart, S.B., LT, NC, USNR-R, re- 
search and Navy nurses: challenging 
the profession 2:26 
Stokes litter 1:13 

Strub, P.M., M.A., CAM1S: Computer 
Assisted Medical Interactive-video 
System 6: 14 

01 S Newport, first year student's im- 
pression of 1:10 

microvascular, training in 5:25 
ophthalmic microsurgery at sea 2:28 
Swartz, S.E., LT, MC, USNR, ulcerative 
colitis: a review 2:6, 3:6 

TAYLOR, R.B., HM1, Sailor of the Year 

Teeth (see Dentistry, Navy) 
Temporomandibular joint (TMJ) 4:23 
The power of perception and the future of 

Navy medicine 3:20 
The war's most incredible document 6:10 
Thomas, H.G., USNS Mercy 5:10 
Titi, R.J., LCDR, MSC, Fleet Marine 

Force dentistry 2:5 
TMJ (temporomandibular joint) 4:23 
Too cold for comfort: NMR1 scientists 

study human adaptability 1:2 
Toth, F., Ph.D., CAM1S: Computer As- 
sisted Medical Interactive-video 
System 6:14, 18, 19 

Computer Assisted Medical Interactive- 
video System 6:14 
law of war course 3:9 
management of mass casualties in the 

aircraft carrier environment 2:15 
microvascular surgery 5:25 
OlS Newport 1:10 
Operation Safe Haven 3:25 
osseointegration in the Dental Corps 4:6 
patient evacuation clerks 1:12 

plateletpheresis 5:20 


mass casualties in the aircraft carrier 
environment 2:15 
Tsetse flies 2: 10 

metastatic carcinoma masquerading as 

retropharyngeal abscess 1:24 
oral care Tor head and neck cancer 
patients undergoing radiation 
therapy 6:7 
screening for colorectal cancer 1:6 
Tzanck smears, plain but practical 4:26 

ULCERATIVE colitis: a review 2:6, 3:6 
Ullman, V., the war's most incredible 

document 6: 10 
Undersea Medical Society changes name 

Urethritis, chlamydial 6:24 
USNS Mercy 3:4. 5:2 
USS Hector 2:28 
USS La Salle 4:4 
USS Seadragon 1:20 

halitosis: diagnosis, clinical signifi- 
cance, prevention, and treatment 5:22 

Van Ness, M.M., LCDR, MC, screening 
for colorectal cancer 1:6 

Vidmar, D.A., CDR, MC, Tzancksmears: 
plain but practical 4:26 

Salle's dental department 4:4 

Wartime mission 4:20 

Weaver, T., LCDR, DC, plain film imag- 
ing of the TMJ 4:23 

Wells, J.K., JO I, plastic surgery and Navy 
medicine 3:2 

Wilson, C.S., LT, MC. USNR, manage- 
ment of mass casualties in the aircraft 
carrier environment 2:15 

Wolov, R.B.. LCDR, MC, orthopedics 
afloat: the lower extremities 1:26 

World War 11 

appendectomy performed aboard USS 

Seadragon 1:20 
the war's most incredible document 6: 10 


plain film imaging of the TMJ 4:23 

YACK, R.W., HMCM, military medicine 



assumes duty as Surgeon General and 

Director of Naval Medicine 4:29 
a time for new beginnings 5:13 
Navy dentistry: asset past and future 4: 1 
outreach 6:1 

November-December 1987 

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